CHILDHOOD IMMUNIZATION COVERAGE AND HUMAN RESOURCE FOR HEALTH DENSITY IN ASEAN COUNTRIES.

Mohammad Zahirul Hoque , Fumitaka Furuoka Beatrice Lim , Khaled Shamsul Islam . School of Medicine, University Malaysia Sabah, Locked Bag No. 2073, 88999 Kota Kinabalu, Sabah, Malaysia. 2 School Of Business and Economics, University Malaysia Sabah, Locked Bag No. 2073, 88999 Kota Kinabalu, Sabah, Malaysia. 3 Human Resource Development Unit, Ministry of Health and Family Welfare, Dhaka-1000, Bangladesh.
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INTRODUCTION
Childhood immunization can cause significant reductions in child mortality. Vaccine preventable diseases are the commonest causes of mortality in children. Increasing vaccination coverage is an important step towards reducing under-five mortality rate by two thirds by the year 2015, the fourth Millennium Development Goal (MDG). According to the World Health Organization (WHO) report, childhood vaccinations could have prevented an estimated 2.9 million deaths in children in the year 2007. Thus, improving the immunization coverage remains an important component in reducing the disease burden of children.

METHODOLOGY
The data is obtained from World Health Statistics 2011 published by the World Health Organization (WHO). In particular the numbers and density (per 10,000 populations) of health workers are important variables. The data for immunization coverage include immunization against three vaccinationsmeasles- containing-vaccines (MCV), diptheriatetanus toxoid- and pertussis (DTP3) and hepatitis B (HepB3).

OBJECTIVES
Recent cross-national and cross-sectional findings showed that human resource for health (HRH) densities may positively influence immunization coverage. We were interested to know the association between density of health workers (physicians, Nursing and midwifery personnel) and levels of immunization coverage in ASEAN countries. This paper will look at some important data that determines health services coverage in the ASEAN countries.

RESULT
In the year 2000 to 2009, Singapore has the highest physician density which is 18.3. The numbers of physician in Singapore is 8,323. On the other hand, the number of nursing and midwifery personnel is 26,792. The density (per 10,000 populations) is 59. On the lower end, Lao PDR for example, has 1614 physicians or density of 2.7 (per 10,000 populations). The number of nursing and midwifery personnel is 5,724 and density is 9.7. The number and density of health personnel in a country will influence the quality of medical services in a particular country. In literatures, medical services can be measure by immunization coverage. In the year 2009, the percentage of immunization coverage among 1 year old in Singapore is 95 percent, 97 percent and 97 percent for measles, DTP3 and HepB3 respectively. However, in Lao PDR, it is lower at 59 percent, 57 percent and 67 percent form measles, DTP3 and HepB3.
Table 1: Number and density of physician and nursing personal Country Cambodia Indonesia Malaysia Myanmar Singapore Philippines Lao PDR Vietnam Brunei Darussalam Thailand Physician 3393 (2.3) 65722 (2.9) 25102 (9.4) 23709 (4.6) 8323 (18.3) 92862 (11.5) 1614 (2.7) 107131 (12.2) 564 (14.2) 18918 (3.0) Nursing & midwifery personnel 11736 (7.9) 465662 (20.4) 72847 (27.3) 41424 (8.0) 26792 (59.0) 488434 (60.0) 5724 (9.7) 88025 (10.1) 1941 (48.8) 96704 (15.2) Country Cambodia Indonesia Malaysia Myanmar Singapore Philippines Lao PDR Vietnam Brunei Darussalam Thailand Table 2: Immunazation coverage (%) Measles 92 82 95 87 95 88 59 97 99 98 DPT 94 82 98 90 97 87 57 96 99 99 Hep3 91 82 98 90 97 85 67 94 99 98

Figure 1: Density of Physician & Nurses

125 120 100 25 80 60 5 40 20 1 0

Figure 2: Immunization coverage (%)

Physician

Nursing & midwifery personnel

Measles

DPT

Hep3

CONCLUSION
In general, countries with higher density of health workers have higher percentage of immunization coverage. On the contrary, countries with lower health workers density have lower percentage of immunization coverage. Therefore, our study indicates that health workers density can affect health care services. Our findings suggest that understanding of relationships between human resource for health (HRH) and health services would be of use to government policymakers as well as donor agencies in health sectors.

REFERENCE
1. Anand S, Barnighausen T: Health workers and vaccination coverage in developing countries: an econometric analysis Lancet 2007, 369:1277-85 2. Speybroeck N, Dal Poz MR, Evans DB: Reassessing the relationship between human resources for health, intervention coverage and health outcomes Background paper prepared for The World Health Report 2006. Geneva: World Health Organization, 2006 3. Castillo-Laborde Carla : Human resources for health and burden of disease: an econometric approach. Human Resources for Health 2011, 9:4